Form 3A – Self Exclusion Notice

Responsible Service of GamblingA patron may approach a gambling venue and ask to be officially barred from all or part of the venue. This is called Self-Exclusion. Usually a person will request self-exclusion to prevent oneself from further problem gambling. 

Self-Exclusion is voluntary with which – 

  1. The patron is asked to complete a Self-Exclusion Notice (Form 3A).

  2. The Self-Exclusion Notice is the patron’s consent to prohibit oneself from some parts or the entire venue.

  3. The patron completes and signs the form.

  4. The venue may request a photo to confirm identity (mandatory if the venue is a casino).

The Customer Liaison Officershould assist the patron complete the form which then allows the venue to issue a Self-Exclusion Order (Form 3B).